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Despite an absence of evidence that Rho(D) immune globulin is necessary before first-trimester abortion, current US guidelines are mixed regarding whether routine Rh testing and Rho(D) immune globulin are required. We sought to assess knowledge of blood type, interest in Rh testing, and Rho(D) immune globulin received if Rh-negative among patients receiving direct-to-patient telehealth for medication abortion care and who would not otherwise need to travel to a clinic for care.
We analyzed survey data from patients obtaining medication abortion through telehealth in 21 states and Washington, DC as part of the California Home Abortion by Telehealth Study between October 2020 and January 2021. The survey included questions about patients’ blood type, interest in receiving Rh testing, and whether Rh-negative patients have received Rho(D) immune globulin. Clinics counseled patients about low risks of Rh sensitization early in pregnancy.
Among all 1,378 respondents who answered survey questions on Rh, 713 (51.7%) patients knew their blood type and among these, 172 (24.1%) reported they were Rh-negative. One clinic asked all patients with unknown blood types (n=202) about their interest in Rh testing, among whom 201 (99.5%) were not interested in Rh testing. Among Rh-negative patients, 2.91% did obtain Rho(D) immune globulin.
Most patients who choose telehealth services for medication abortion are not interested in Rh testing or have not received Rho(D) immune globulin. Guidelines that continue to mandate Rh testing and Rho(D) immune globulin for first-trimester abortions should be reconsidered based on low patient interest and lack of demonstrated clinical necessity in the existing literature.
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